Abstract
Background and aims
This study aims to synthesize evidence on dipeptidyl peptidase-4 (DPP-4) inhibitor and mortality in COVID-19 patients and factors affecting it.
Methods
We performed a systematic literature search from PubMed, Scopus, and Embase databases from inception of databases up until 7 March 2021. Studies that met all of the following criteria were included: 1) observational studies or randomized controlled trials that report COVID-19 patients, 2) reporting DPP-4 inhibitor use, 3) mortality, and 4) mortality based on DPP-4 inhibitor use. The exposure was DPP-4 inhibitor, defined as DPP-4 inhibitor use that started prior to COVID-19 hospitalization. The control group was patients with no exposure to DPP-4 inhibitor. The outcome was mortality. The pooled effect estimate was reported as risk ratio (RR).
Results
There were 4,477 patients from 9 studies in this systematic review and meta-analysis. 31% of (15%, 46%) the patients use DPP-4 inhibitor. Mortality occurs in 23% (15%, 31%) of the patients. DPP-4 inhibitor was associated with lower mortality in patients with COVID-19 (RR 0.76 [0.60, 0.97], p = 0.030, I2: 44.5%, p = 0.072). Meta-regression analysis showed that the association between DPP-4 inhibitor and mortality was significantly affected by metformin (RR 1.02 [1.00, 1.04], p = 0.048) and angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) use (RR 1.04 [1.01, 1.07], p = 0.006), but not age (p = 0.759), sex (reference: male, p = 0.148), and hypertension (p = 0.218).
Conclusion
DPP-4 inhibitor use was associated with lower mortality in COVID-19 patients, and the association was weaker in patients who were also taking metformin and/or ACE inhibitors.
【저자키워드】 COVID-19, SARS-CoV-2, Mortality, diabetes, Dipeptidyl peptidase-4 inhibitor, 【초록키워드】 Randomized controlled trial, Meta-analysis, systematic review, Sex, risk, outcome, hypertension, ACE inhibitors, database, observational study, Dipeptidyl peptidase-4, male, Patient, COVID-19 hospitalization, age, inhibitor, patients, COVID-19 patients, association, angiotensin receptor blocker, Evidence, Analysis, COVID-19 patient, criteria, Factor, control group, enzyme, lower mortality, systematic literature search, Result, defined, performed, affected, significantly, reported, the patient, occur, affecting, patients with COVID-19, 【제목키워드】 coronavirus disease, Meta-analysis, systematic review, meta-regression, inhibitor,